Gastritis
The inside of the stomach is lined with a mucous membrane that spends all day sitting in an acid strong enough to dissolve a piece of meat.
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Medicines commonly prescribed for Gastritis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 250 mg/5 mlActive substance: amoxicillinManufacturer: Sandoz Farmaceutica S.A.Prescription requiredDosage form: TABLET, 40 mg pantoprazoleActive substance: pantoprazoleManufacturer: Takeda GmbhPrescription requiredDosage form: TABLET, 1000 mgActive substance: amoxicillinManufacturer: Glaxosmithkline S.A.Prescription required
The inside of the stomach is lined with a mucous membrane that spends all day sitting in an acid strong enough to dissolve a piece of meat. It survives that thanks to a layer of mucus, to bicarbonate and to cells that renew themselves extremely fast. Gastritis is what happens when those defences stop coping and the lining becomes inflamed. Behind the single word lie very different stories: for one person it is a few days after a course of painkillers, for another a long-standing infection that clears with a fortnight of treatment, for a third a slow remodelling of the lining that is watched for years. That is why the useful question is not "what can I take for my stomach" but "what is damaging it".
How the stomach lets you know
The complaints of gastritis are undramatic and easily blamed on last night's dinner. Most often they are:
- a dull or burning pain high in the abdomen, sometimes on an empty stomach, sometimes straight after eating;
- feeling full when half the plate is still there;
- bloating, belching and rumbling;
- queasiness and, now and then, vomiting;
- loss of appetite and a distaste for fatty food;
- an unpleasant taste in the mouth and bad breath.
You cannot tell from these sensations what is happening inside. The severity of the symptoms and the severity of the inflammation match poorly: someone in real pain may have an almost clean lining, while someone who feels nothing at all turns out on endoscopy to have deep changes. This is particularly true of damage from painkillers, which often runs entirely silently and announces itself as a bleed. So symptoms are a poor basis for diagnosing yourself and an even poorer basis for reassuring yourself.
When to call an ambulance, and when to see a doctor this week
Call an ambulance straight away if any one of these appears:
- vomiting bright red blood, or dark material that looks like coffee grounds;
- black, tarry, strong-smelling stools;
- sudden severe abdominal pain that stops you straightening up, with a rigid abdomen;
- marked weakness, cold sweat, fainting or a racing pulse alongside stomach pain.
That is what bleeding and perforation look like, and with those the clock runs in hours. Do not drive yourself and do not wait until morning: ask someone to take you or call an ambulance — in Spain, Italy, Portugal, Poland and Ukraine the single European number 112 is used for this. Take the list of your medicines with you; it will tell a doctor more than a long account will.
Book an appointment within the next few days if pain or heaviness lasts longer than a week, keeps coming back, or you find yourself constantly silencing it with over-the-counter remedies. Do not put the visit off either if weight loss without dieting, difficulty swallowing, repeated vomiting or growing pallor and breathlessness on exertion have joined the picture: those combinations are investigated sooner than the rest.
Where the inflammation comes from
There are only a few causes and they are well understood. The commonest is the bacterium Helicobacter pylori. It lives in the mucus on the surface of the stomach, neutralises the acid around itself and keeps a low-grade inflammation going for years. Infection is usually picked up in childhood, within the family, through shared crockery and everyday contact; carrying it is very common and in most people it shows no signs at all.
The second commonest cause is anti-inflammatory painkillers: ibuprofen, diclofenac, naproxen, ketorolac and aspirin. They cut the production of the substances that maintain the protective mucus layer, and they do so throughout the body, so a suppository or an injection is no safer than a tablet. The risk is higher with long-term use, in older people, when several such drugs are combined, and when they are taken alongside steroids or blood-thinning medicines.
Next come alcohol, spirits on an empty stomach above all, and smoking, which worsens the blood supply to the stomach wall. A separate story is the body under severe strain: major surgery, extensive burns, sepsis or shock, when the lining suffers from poor perfusion.
Less common is autoimmune gastritis, in which the immune system attacks the stomach's own glands by mistake. It builds up over years with almost no digestive complaints, while quietly stripping the body of vitamin B12 and iron. The person comes in with tiredness, breathlessness, tingling fingers and an unsteady walk, and the cause turns out to be in the stomach. This form is worth bearing in mind for anyone who already has another autoimmune condition — thyroid disease or type 1 diabetes, for instance.
How the cause is found
Investigation starts by looking for Helicobacter, because the whole of treatment hangs on that result. A urea breath test, a stool test for the bacterial antigen or a biopsy taken at endoscopy are used. A blood antibody test serves less well: it stays positive long after the infection has gone.
The tests need preparation or the result will be falsely negative. Acid-suppressing drugs are stopped roughly two weeks beforehand, antibiotics and bismuth preparations about four. The exact intervals will be given by the doctor requesting the test. A full blood count is usually added so that hidden blood loss is not missed, along with iron studies.
Endoscopy is not for everyone. It is arranged when symptoms are stubborn, when treatment has failed, when the warning signs listed above are present, or when the complaints have appeared for the first time in an older person. The doctor sees the lining directly and takes pieces of tissue: only that distinguishes surface inflammation from atrophy and confirms that nothing more serious is going on.
What treatment involves
Treatment is built around the cause that has been found, not around the word written in a report.
- If Helicobacter is present, eradication is prescribed: two or three antibiotics together with an acid-suppressing drug, for about a fortnight. The doctor picks the regimen with local bacterial resistance in mind and with an eye on which antibiotics you have had before. Finishing the full course matters, and a month after it ends the infection should be checked for again.
- Acid is reduced with proton pump inhibitors and, less often, with histamine receptor blockers. They do not remove the cause, but they give the lining a chance to heal.
- Antacids and alginates act quickly and briefly: the first neutralise acid, the second form a film on top of the stomach contents. They are for occasional relief, not for hiding symptoms behind for months.
- If painkillers are to blame, discuss with your doctor whether they can be swapped or the dose lowered. When they cannot be stopped — aspirin prescribed to protect the heart, say — it is kept on, but stomach protection is added. Deciding this by yourself is dangerous in both directions.
- Where alcohol is the cause, no tablet will work while the drinking continues.
There is no diet that cures gastritis on its own, and rigid restrictive regimes have not proved their worth. It makes sense to drop whatever personally brings on your pain, and not to punish yourself with puréed food for years.
What everyday habits decide
Eat smaller amounts more often, and finish your last meal about three hours before bed; if there is burning in the chest at night, raise the head of the bed. Cut down on coffee, strong tea, cola and energy drinks, especially on an empty stomach, and drop spirits altogether at least while treatment lasts. Stopping smoking is hard, but tobacco is what delays healing more than anything else. Losing excess weight reduces the pressure on the stomach and the reflux into the gullet. And keep in mind that a painkiller bought off the shelf for a headache is a medicine too, with its own bill for the stomach.
What is risked by letting it run
Gastritis left unattended does not always stay harmless. Its commonest sequel is a stomach or duodenal ulcer, and from there it is a short step to bleeding and perforation. With inflammation lasting many years the lining may thin out and be replaced by tissue resembling that of the intestine; this state is called atrophic gastritis with metaplasia and it raises the risk of stomach cancer appreciably. There is no cause for alarm: the road takes decades, and people with such changes are offered periodic endoscopy precisely in order to catch a problem at its beginning.
There is also a rare but important turn: prolonged Helicobacter infection sometimes sets off an unusual tumour of the lymphoid tissue of the stomach. Its distinguishing feature is that at an early stage it can disappear after ordinary eradication of the bacterium, with no chemotherapy. Another scenario is the autoimmune form with vitamin B12 deficiency: if that is not replaced, the neurological changes eventually become irreversible. All of it argues for sorting out the cause once rather than living on antacids for years.
Online consultation
A remote appointment covers a good part of the route when the trouble is gastric. The doctor will ask when it hurts and what it is linked to, go through your medicine cabinet and find the drugs that could have started it all, explain whether you need an endoscopy or whether a breath test is a reasonable place to begin, and issue the requests for the tests. Another use is making sense of reports you already have: phrases like "erythematous gastropathy" or "focal atrophy" sound alarming and stand for things of very different weight. Online is also a convenient way to run the treatment itself: to check the eradication regimen, to decide what to do about the side effects of antibiotics, when to confirm the result and how much longer to stay on the acid-suppressing drug. The one thing that does not belong in this format is trying to sit out the warning signs. Vomiting blood, black stools and sudden severe abdominal pain are not discussed by message but with an ambulance.
This material is for information only and does not replace medical advice.
Consult with a doctor about Gastritis
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Gastritis
Discuss your symptoms and possible next steps for Gastritis with a doctor online.
